中国神经再生研究(英文版) ›› 2021, Vol. 16 ›› Issue (5): 856-864.doi: 10.4103/1673-5374.297081

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

周围神经二次松解过程中注射自体脂肪间充质干细胞有利于感觉和运动功能恢复

  


  • 出版日期:2021-05-15 发布日期:2020-12-29
  • 基金资助:


Secondary release of the peripheral nerve with autologous fat derivates benefits for functional and sensory recovery 

Natalia E. Krzesniak1, *, Anna Sarnowska2, Anna Figiel-Dabrowska2, Katarzyna Osiak1, Krystyna Domanska-Janik2, Bartłomiej H. Noszczyk1   

  1. 1 Department of Plastic and Reconstructive Surgery, Center of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland  2 Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
  • Online:2021-05-15 Published:2020-12-29
  • Contact: Natalia E. Krześniak, MD, natalia.krzesniakmd@gmail.com.

摘要:

创伤性周围神经损伤后进行无张力端端吻合以重建神经连续是外科手术的金标准。然而,少数病例会出现运动或感觉功能结局不理想现象,同时会伴随神经瘢痕限制了神经再生过程。此时,需要进行二次神经松解。已有临床前研究中观察到动物实验中观察到脂肪间充质干细胞具有抗神经周围瘢痕组织及神经外膜内瘢痕组织形成的潜力。然而,脂肪间充质干细胞在周围神经重建中的临床应用效果尚较少见报道。为评估二次周围神经松解过程中未分化的脂肪间充质干细胞的支持作用。纳入3例首次正中神经和尺神经重建失败的患者(1例女性,2例男性;受伤时的平均年龄为59.0±4.5岁),在二次翻修手术中,松解神经束,并沿神经束和邻近组织周围显微注射脂肪间充质干细胞。在36个月的随访中,患者感觉到感觉功能逐渐恢复,且未观察到不良反应。在脂肪间充质干细胞支持下同时松解神经,神经重建后需要二次神经松解的或可能成为一种很有前途的改善患者功能的方法。

https://orcid.org/0000-0002-3608-3472 (Natalia E. Krześniak)

Abstract: The reconstruction of nerve continuity after traumatic nerve injury is the gold standard in hand surgery. Immediate, tension-free, end-to-end nerve suture ensures the best prognosis. The recovery is mostly promising; however, in a few cases, insufficient outcomes in motor or sensory function are observed. Intra- and extra-fascicular scarring accompanies the nerve regeneration process and limits final outcomes. Secondary nerve release in those cases is recommended. Unfortunately, scarring recurrence cannot be eliminated after secondary revision and neurolysis. The supportive influences of mesenchymal stem cells in the process of nerve regeneration were observed in many preclinical studies. However, a limited number of studies in humans have analyzed the clinical usage of mesenchymal stem cells in peripheral nerve reconstruction and revisions. The objective of this study was to evaluate the effects of undifferentiated adipose-derived stromal/stem cell injection during a last-chance surgery (neurolysis, nerve release) on a previously reconstructed nerve. Three patients (one female, two males; mean age 59 ± 4.5 years at the time of injury), who experienced failure of reconstructions of median and ulnar nerves, were included in this study. During the revision surgery, nerve fascicles were released, and adipose-derived stromal/stem cells were administered through microinjections along the fascicles and around the adjacent tissues after external neurolysis. During 36 months of follow-up, patients noticed gradual signs of sensory and in consequence functional recovery. No adverse effects were observed. Simultaneous nerve release with adipose-derived stromal/stem cells support is a promising method in patients who need secondary nerve release after nerve reconstruction. This method can constitute an alternative procedure in patients experiencing recovery failure and allow improvement in cases of limited nerve regeneration. The study protocol was approved by the Institutional Review Board (IRB) at the Centre of Postgraduate Medical Education (No. 62/PB/2016) on September 14, 2016. 

Key words: nerve release, neurolysis, stem cells, adipose-derived stem cells, scar, threshold, sensation, pain, hypersensitivity, forearm